Full Parenteral Nutrition (TPN) Support

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Parenteral nutrition concerns intravenous nutrition supplements. Access may be peripheral veins or central veins. Peripheral venous access is usually used for short-term assistance and limits the amount of fluid and nutrients that can be transported. Whenever possible, enteral nutrition is advantageous to provide nutrients in the intestine and maintain the anti-gland.

Parenteral Nutrition Indications

Parenteral nutrition is used for intestinal disease or severe gastrointestinal disease. Catheter-associated sepsis poses a significant risk to immunodeficiency patients. In HIV / AIDS, TPN induces weight gain, the composition of which depends on the underlying aetiology of malnutrition. Septic patients primarily receive fat, while the body mass is greater in absorption or inadequate food intake. This mode may not be available in the region. However, this is an option that needs to be followed if necessary.

Components of parenteral nutrition

The ingredient of parenteral nutrition consists of nutrients that are simple in form, rarely dextrose, amino acids, lipids, and micronutrients. Dextrose is the monosaccharide, which provides the main source of the non-protein source. In parenteral solutions, each gram of dextrose provides 3.4 kilocalories or 14.2 kilohoules. Carbohydrate should be provided in sufficient quantities to spare proteins, but not too large as this may cause hyperglycemia, fatty liver or other complications. The recommended amount of dextrose infusion should not exceed 4-5 mg / kg / min. Amino acids provide the protein to maintain nitrogen balance and prevent degradation of somatic proteins. The protein requirements are calculated on the basis of the clinical condition and the purpose of the treatment. Amino acid solutions contain 4 kilocalories per gram or 18.1 kilograms per gram. Parenteral lipid emulsions provide concentrated energy and essential fatty acids. They can be used with carbohydrates and amino acid solutions or alone to increase calories. The energy content of the lipid emulsions depends on the composition. Ten percent yield: 1 kg / ml; 20% yield of 2.0 kg / ml; 30% yield 0.3 kg pounds / ml. There is some evidence that parenal lipids may have a negative effect on immunity. In patients with HIV infection, lipids should not exceed 30% or 1 g / kg / day of total energy intake. Hyperlipidemia may also occur if the lipids are not purified. Serum lipids should therefore be checked on the baseline and at regular intervals. Micronutrients and electrolytes are standardized components of parenteral solutions. They can be modified to meet the patient's needs.

Anabolic Therapy

Nutrition Support Generally results in weight gain, but some non-responding PLWHAs have anabolic block evidence, while stored weight consists of disproportionately large amounts of body fat with a limited accumulation of lean tissue. This phenomenon can be identified by body composition analysis. Thus, although feeding is always necessary, it is not always enough. In cases where lean tissue gains are insufficient, anabolic agent such as testosterone may be needed. Anabolic therapies with other beneficial results include Oxandrin, Decadurabolan and Recombinant Growth Hormone.

Palliative Care

When AIDS patients become fatal and medical care is primarily palliative and non-healing, a nutrition care plan should reflect the overall care goals. Nutrition therapy aims at alleviating symptoms and providing comfort. Support for nutrition should be considered to improve the quality of life if the patient, the caregivers and the medical team agree to this intervention.

General Nutrition Problems

There may be a lot of eating problems during treatment and care. Strategies for alleviating common problems are concerned with physiological stress caused by pregnancy, lactation and HIV

pregnancy, lactation and HIV infections, increased nutritional needs for energy, protein and micronutrients. It has been recognized that the nutritional health of pregnant women results in the abortion of pregnancy. Nourishing

status has an even greater impact on HIV-infected women who are at greater risk of premature delivery and have a low birth weight infant.

Babies with low birth weight infant mortality and medical and developmental complications are more common. Other risk factors, such as adolescent pregnancy, substance use, opportunistic infection, low pre-pregnancy weight and sufficient pregnancy weight gain, pose another risk to poor pregnancy outcome. In addition, vitamin A deficiency was associated with poor pregnancy outcome and increased risk of perinatal HIV infection. Pregnant HIV-positive women should be referred to a dietitian or other appropriate healthcare professional at an early stage of pregnancy in order to optimize nutritional status and to improve the outcome of pregnancy. It is essential to evaluate additional therapeutic use as the mega doses of vitamins and certain herbal preparations are contraindicated during pregnancy.

Weight gain in pregnancy

Recommended weight gain based on weight before pregnancy:

Underweighted (BMI 25):

Nutritional requirements

12. 5-18. 0 kg

11. 5-16. 0 kg

7. 0-11. 5 kg

According to dietary supplements for use in the Caribbean, the following requirements for pregnancy / lactation are in addition to the requirements for HIV + women:

4? A further 285 kg / day for fetal growth and development

6 grams of protein per day

Multiple multivitamin mineral daily (at least 0.4 mg folic acid)

Other micronutrient supplements as needed (eg iron, calcium )

Breastfeeding: Another 500 kcal per day and 11 grams of protein A Vitamin A:

Maternal vitamin A deficiency is associated with increased risk of vertical HIV infection for the infant. However, there is little evidence that supplementing vitamin A with a pregnant woman reduces infant HIV infection. Additionally, high-dose vitamin A may be teratogenic. If a supplement is required, the following WHO guidelines may be used.

Iron-deficiency anemia is prevalent in pregnant women around the world. Anemia is associated with increased risk for maternal and fetal illnesses and death and intrauterine growth disorders. You have to estimate the iron state and handle the deficiency. WHO recommends that women receive 60 mg of iron for 6 months of pregnancy and 120 mg of severe anemia per day.

Lack of follicle:

Lack of folate causes megaloblastic anemia and inflicts the infant's neural tube defects (eg Spina bifida). The WHO offers 0.4 mg folate supplements per day.

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